It is important to be careful when using any drugs, especially
those sold on the black market. You never really know what you are getting
unless you test your pills because many drug dealers trying to make as much
money as possible will sell pills they call ecstasy which could contain anything.
A multitude of different substances have been found in pills claiming to
MDMA. Some of these fakes are very dangerous, and can even be lethal. You
can visit www.dancesafe.org for much more
information on testing pills and pills that have been found to have dangerous
substances. If you do choose to use MDMA there are steps which can amke
it a safer experience. It is important to stay well hydrated, as MDMA can
make you overheat quite quickly.

Many of the effects of MDMA are attributed to its influence
on serotonin a major neurotranmitter
in the brain.It is easy to speculate as to why selective serotonin reuptake inhibitors (SSRIs)
would have a strong influence on MDMA's effects, as they affect MDMA's influence
on serotonin. When prozac, the most popular SSRI, is taken shortly before
ingestion of MDMA it greatly reduces the effect of serotonin depletion usually
caused by MDMA. Though the effects of MDMA can be quite dramatic, there
are more deaths per year from motor cycling or glue sniffing then MDMA use.
When deaths do occur from MDMA they are often from hyperthermia (overheating),
and the increased body temperature can snowball into many problems including
liver and kidney failure. Some theorize that most deaths from MDMA are due
to heat stroke, which is brought on by many common MDMA experiences such
as:

Dancing Long Into the Night

Failing to take breaks from dancing

Being in Clubs that are hot and Humid

So what do I do if I think someone is ill from MDMA?
"The first thing to say in that most of the untoward effects of taking
an E will be self limiting. A sensation of heat, a sense of the heart going
faster, nausea, teeth clenching and visual disturbance may all be regarded
as the 'normal' effects of a dose of ecstasy. Not everyone who has taken
a tablet will like these effects. Many people will feel they have started
something they cannot control and will feel fearful that they cannot stop
themselves being carried along by the experience. They will be aware of
where they are and what day it is, but they will be anxious and fearful.
Get them out of the noise and the bright lights. Stay with them. Be reassuring.
Give them a drink to sip but be careful they do not attempt to drown their
anxiety in water. If possible try and get them to drink an 'isotonic' or
sports type drink. Tell them they will be all right and take them home.
Don't leave them alone, just in case they become worse."

Jones also tells us some warning signs for when a person
is in real trouble under the influence of MDMA:

* Disorientation in time and place. They can't say where
they are or what day it is.
* Drowsiness that comes to be unresponsive to commands like "open
your eyes" or "squeeze my hand".
* Anything which looks like fitting.
* Breathlessness or difficulty breathing.
* They feel abnormally hot to your touch even though they have been in
a cool environment for some time.
At this point it is time for professional advice and a trip to hospital.
You will be treated in confidence and with respect by the medical and nursing
staff.

For paramedics and nurses who encounter someone suffering
from the adverse side effects of MDMA Jones Suggest you take this route
to determine the severity of the problem:

Is the person conscious? If No, ring ambulance.
* Is there a normal level of consciousness? (Do they know where they are
or what day it is?) If No, ring ambulance.
* Can you detect any physical problems? eg. Racing pulse (over 120/min
over five minutes of quiet and rest), high temperature, abnormal prolonged
sweating or breathlessness. If Yes, ring ambulance.
* Put in recovery position. Sit down, observe for levels of consciousness,
heart rate, temperature.
* Do not give anything by mouth rate, temperature.
* Keep off dance floor.
* Check pulse.
* Do not leave alone.
* Assess temperature.
* Remove excess clothing.
* Commence cooling - fan/water.
* Observe for unusual bruising/bleeding.

The symptoms associated with MDMA often confuse doctors
who see them for the first time, and this is compounded by patients who
usually either are unconscious or do not wish to divulge what they have
ingested.

One physical problem associated with MDMA use that should
be easily preventable is tooth decay. Dry mouth, jaw tension, and tooth
grinding are common side effects of MDMA. A.
Milosevic; N. Agrawal; P. Redfearn; and L Mair were involved in a study
that investigated the amount of tooth wear in MDMA users and non-users.
There was more severe tooth decay found in the MDMA users, and more of their
teeth were affected. Many guides for MDMA use stress the importance of drinking
plenty of water to prevent dehydration, but they tend to lack information
on the danger of drinking too much water. Although hypernatremia (drinking
enough water to die) is a rare problem caused by drinking enough water to
dillute the levels of salt in your body MDMA increase the likelihood of
it occuring.

Hypernatremea is farely common as a cause of ecstasy deaths,
though these deaths in general are very rare. Hyperthermia (over heating
of the body) is another likely complication of MDMA use if precautions are
not taken. Hyperthermia is a problem because MDMA raises the body temperature,
increase activity, and makes many users overlook how much they have exhausted
themselves.
Danger can also come from the lessened awareness of pain that results from
MDMA consumption. Because MDMA users are so active, and they have a decreased
sensitivity to pain there is an increased likelihood for injury. The combination
of effects of MDMA on the body and the decreased awareness it causes in
the mind can create many problems if users do not pay special attention
to their bodily functions.